Is Penicillin Allergy a Risk Factor for Surgical Site Infection After Oral and Maxillofacial Surgery?

Roistacher, Daniel M.; Heller, Joshua A.; Ferraro, Nalton; August, Meredith

doi:10.1016/j.joms.2021.08.147

Cited by 18 publications

(15 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, penicillin allergy appears to be a risk factor for SSI, and these data seem to be in line with the literature: relative risk multiplied by 2.6 in patients treated with Clindamycin (Dalacine ® ) in the study of Roistacher et al [ 6 ], and there is a decrease in SSI in patients treated with Amoxicillin–Clavulanic Acid (Augmentin ® ) in the study of Barrier et al [ 7 ]. To remedy this, it appears necessary, first, to identify true allergies to penicillin.…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Does Penicillin Allergy Increase the Risk of Surgical Site Infection after Orthognathic Surgery? A Multivariate Analysis

Bertin

Meyer

Chatelain

et al. 2022

JCM

View full text Add to dashboard Cite

This study aimed to demonstrate an association between the occurrence of surgical site infection (SSI) after orthognathic surgery and penicillin allergy and to assess whether other factors could be associated with the occurrence of SSI. A 10-year monocentric retrospective study was conducted to identify possible risk factors for SSI in orthognathic surgery. Bivariate analyses were performed using Fisher, Student, or Wilcoxon tests and multivariate analyses using logistic regression. Two hundred and sixty-six patients were included, and 3.5% had SSI. Bivariate analyses revealed a significant association between SSI and age at surgery (p = 0.01), penicillin allergy (p = 0.02), and postoperative antibiotic therapy by Clindamycin (Dalacine®) (p = 0.02). Multivariate analyses confirmed the association between the occurrence of SSI and treatment with Clindamycin (Dalacine®) or Clindamycin (Dalacine®) and Metronidazole (Flagyl®) postoperatively (p = 0.04). Antibiotic therapy with Clindamycin (Dalacine®) seems to be associated with a higher rate of SSI, and the mandible was the only site affected by SSI.

show abstract

Section: Discussionsupporting

confidence: 92%

“…The antibiotic used also varies among studies. Amoxicillin–Clavulanic Acid (Augmentin ® ) is the most effective antibiotic treatment against oral micro-organisms, and few studies showed an increased risk of SSI in patients with penicillin allergy [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Does Penicillin Allergy Increase the Risk of Surgical Site Infection after Orthognathic Surgery? A Multivariate Analysis

Bertin

Meyer

Chatelain

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…Clindamycin is frequently prescribed for penicillinallergic patients as an alternative to oral surgery; however, researchers have recently reported on the lack of highquality clinical evidence for its use in oral implant surgery [28,36,[48][49][50]. Clindamycin is a broad-spectrum antibiotic with activity against aerobic, anaerobic, and β-lactamaseproducing pathogens.…”

Section: Discussionmentioning

confidence: 99%

The effect of preoperative clindamycin in reducing early oral implant failure: a randomised placebo-controlled clinical trial

et al. 2022

View full text Add to dashboard Cite

Objectives To assess the effect of preoperative oral clindamycin in reducing early implant failure in healthy adults undergoing conventional implant placement. Materials and methods We conducted a prospective, randomised, double-blind, placebo-controlled clinical trial in accordance with the ethical principles and Consolidated Standards of Reporting Trials statement. We included healthy adults who underwent a single oral implant without previous infection of the surgical bed or the need for bone grafting. They were randomly treated with a single dose of oral clindamycin (600 mg) 1 h before surgery or a placebo. All surgical procedures were performed by one surgeon. A single trained observer evaluated all patients on postoperative days 1, 7, 14, 28, and 56. Early dental implant failure was defined as the loss or removal of an implant for any reason. We recorded the clinical, radiological, and surgical variables, adverse events, and postoperative complications. The study outcomes were statistically analysed to evaluate differences between the groups. Furthermore, we calculated the number required to treat or harm (NNT/NNH). Results Both the control group and clindamycin group had 31 patients each. Two implant failures occurred in the clindamycin group (NNH = 15, p = 0.246). Three patients had postoperative infections, namely two placebo-treated and one clindamycin-treated, which failed (relative risk: 0.5, CI: 0.05–5.23, absolute risk reduction = 0.03, confidence interval: − 0.07–0.13, NNT = 31, CI: 7.2–∞, and p = 0.5). One clindamycin-treated patient experienced gastrointestinal disturbances and diarrhoea. Conclusions Preoperative clindamycin administration during oral implant surgery in healthy adults may not reduce implant failure or post-surgical-complications. Clinical relevance Oral clindamycin is not efficacy. Trial registration The present trial was registered (EudraCT number: 2017-002,168-42). It was approved by the Committee for the Ethics of Research with Medicines of Euskadi (CEIm-E) on 31 October 2018 (internal code number: 201862) and the Spanish Agency of Medicines and Medical Devices (AEMPS) on 18 December 2018.

show abstract

“…19 In fact, studies regarding various types of surgical procedures-including orthopedic, maxillofacial, gynecologic, gastrointestinal, and cardiac-reveal that about 90% of patients reporting a penicillin allergy receive an alternative prophylactic antibiotic rather than cefazolin, most likely because of the aforementioned misconceptions. 18,26,27 While a recent study by Lehmann et al suggests that prophylactic antibiotics do not improve outcomes in endoscopic sinus surgery, 28 the reality remains that many rhinologists use antibiotics in the perioperative period. 5 As such, the pervasive misunderstanding of cephalosporin cross-reactivity with penicillins leads to the unnecessary use of alternative antibiotics during rhinologic surgery in patients reporting a penicillin allergy, with clindamycin as a common substitute.…”

Section: Misconceptions Of Cephalosporin Cross-reactivitymentioning

confidence: 99%

“…Despite the reduced cross‐reactivity with penicillins, use of cefazolin during the perioperative period is hindered in patients labeled with a penicillin allergy due to the existing belief in historical cross‐reactivity rates and a misunderstanding of the true nature of what mediates cross‐reactivity between cephalosporins and penicillins 19 . In fact, studies regarding various types of surgical procedures—including orthopedic, maxillofacial, gynecologic, gastrointestinal, and cardiac—reveal that about 90% of patients reporting a penicillin allergy receive an alternative prophylactic antibiotic rather than cefazolin, most likely because of the aforementioned misconceptions 18,26,27 . While a recent study by Lehmann et al.…”

Section: Consequences Of Penicillin Allergy Labelsmentioning

confidence: 99%

Inaccurate penicillin allergy labels: Consequences, solutions, and opportunities for rhinologists

Liu

McCoul

Brooks

et al. 2023

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Summary A patient‐reported history of penicillin allergy is a common label with a prevalence of about 10%. However, as many as 95% of patients reporting a penicillin allergy do not have a true immunoglobin‐E (IgE)‐mediated allergic reaction. Unfortunately, penicillin allergy mislabeling is problematic, leading to inappropriate antibiotic use and negative consequences, such as adverse drug events, suboptimal outcomes, and increased costs. As physicians who treat patients of all ages for common sinonasal pathology in the clinic and operating room in addition to frequently providing testing and management of allergic diseases, rhinologists are well positioned to aid in delabeling patients with inaccurate penicillin allergies. This viewpoint highlights the consequences of inaccurate penicillin allergy designation in the clinic and perioperative period and explores misconceptions regarding cross‐reactivity between penicillins and cephalosporins. Opportunities are explored for shared decision‐making with colleagues in other specialties, such as anesthesiology, and practical recommendations are provided to aid rhinologists when faced with a patient who holds a questionable history of penicillin allergy. Rhinologists can play an active role in delabeling patients with inaccurate penicillin allergies with the goal of ensuring appropriate antibiotic use for future medical encounters.

show abstract

Is Penicillin Allergy a Risk Factor for Surgical Site Infection After Oral and Maxillofacial Surgery?

Cited by 18 publications

References 38 publications

Does Penicillin Allergy Increase the Risk of Surgical Site Infection after Orthognathic Surgery? A Multivariate Analysis

Does Penicillin Allergy Increase the Risk of Surgical Site Infection after Orthognathic Surgery? A Multivariate Analysis

The effect of preoperative clindamycin in reducing early oral implant failure: a randomised placebo-controlled clinical trial

Inaccurate penicillin allergy labels: Consequences, solutions, and opportunities for rhinologists

Contact Info

Product

Resources

About